Premenstrual asthma: A myth or a reality?

Abstract: Background: Changes in sex hormone levels, occurring both in premenstrual phase and in menstrual cycle, can affect pulmonary function and inflammation, favoring, the onset of premenstrual asthma (PMA). However, to date, due to the lack of consistent data, this clinical entity is not well characterized. Objective: This systematic review aims to analyze the latest data and advances on the PMA. Methods: Following PRISMA guidelines, a literature search of PubMed and Science Direct for peerreviewed journal articles in English through January 2000 with updates through to October 2016 was conducted. Relevant publications were reviewed that included pediatric and adult populations. Information about the study design, sample, intervention, comparators, outcome, time frame, and risk of bias was collected for each article. Results: Out of 57 reviewed reports, 18 were included in this systematic review. Due to the lack of consistent and unanimous literature data, the definition, prevalence, underlying pathogenic mechanisms, and treatment of PMA are not well characterized. In fact, whether some authors required only the patient’s subjective manifestation to make PMA diagnosis, others authors needed objective criteria, such as pulmonary function tests. Whether changes in sex hormones levels were considered as the major risk factors associated with PMA, other authors did not confirm the strength of this relationship. Moreover, treatment regimens for PMA are still inconclusive. Conclusion: Multicenter studies are needed to better develop an evidence-based approach to pathophysiology, prevalence, diagnosis and natural history of the disease.